North Carolina does almost nothing to ensure hospital patients are billed fairly, offered the financial help they need or protected from overly aggressive collections practices, according to one 50-state survey.

The study – conducted by Community Catalyst, a Boston-based group that works to improve access to health care – shows that North Carolina is not among the states that require hospitals to provide free care to needy patients or to notify patients about the availability of such care.

“Can I get the care I need without putting my family in financial distress?” asked Jessica Curtis, director of the Hospital Accountability Project for Community Catalyst. “(No law) in North Carolina will give the answer to that question.”

According to the study, North Carolina is not among:

• The 30 states that require hospitals to disclose the charity care or uncompensated care they provide.
• The 13 states that require some medical providers to give free care to those without the ability to pay. New York, for instance, requires hospitals to provide aid to patients earning up to 300 percent of the poverty level.
• The 15 states that have set billing and collection policies specific to medical debt.
• The seven states that limit what hospitals may charge uninsured patients – or how much patients must pay out of pocket for care.

Under state law, hospitals are free to take legal action against patients who don’t pay their bills.

In fact, state law specifically allows public hospitals to garnishee the wages of some patients. With court orders, hospitals can garnishee as much as 10 percent of a patient’s wages to collect unpaid bills – provided the debtor’s family income is more than twice the federal poverty level.

Some other states have enacted laws limiting hospital collection practices.

Illinois prohibits hospitals from taking legal action against uninsured patients who can’t pay their bills. California bans hospitals from garnisheeing the wages of patients who are eligible for full or partial charity care.

Texas stipulates how much nonprofit hospitals must spend on charity care and other community benefits. North Carolina does not.

Officials with N.C. Hospital Association contend the state doesn’t need more laws because voluntary guidelines now in place are sufficient.

The association asks its member hospitals to report their charity care policies and the amounts they spend on financial assistance. The association posts the information on its website: https://www.ncha.org/issues/community-benefit.

Asked whether such reporting should be mandated statewide, association spokesman Don Dalton said, “If you have a voluntary system that works, why mandate it?”

But The News & Observer and The Charlotte Observer found that more than a third of North Carolina hospitals didn’t publish key details about charity care policies on their Web pages.

Adam Searing, director of the N.C. Justice Center’s Health Access Coalition, said it has become clear to him and his colleagues that North Carolina needs better laws to protect patients.

“Going around the state, I’ve heard too many stories of people being turned away from hospitals who need care,” Searing said. “It is an embarrassment.”